Hiatal Hernia Repair

What this procedure is

A hiatal hernia repair is a surgery to fix a problem where part of your stomach has moved up into your chest. Normally, your stomach sits below a large muscle called the diaphragm. If the opening in that muscle (the hiatus) becomes too wide, the stomach can slide upward. This surgery moves the stomach back into its proper place in the belly.

During the procedure, your clinician may tighten the opening in the diaphragm with stitches to prevent the stomach from sliding up again. In many cases, they also perform a "fundoplication." This involves wrapping the top part of the stomach around the bottom of the esophagus (the food tube) to help keep everything in place and prevent acid from leaking upward.

What it treats or fixes

This surgery is primarily used to treat a hiatal hernia and the uncomfortable symptoms it can cause. While many people have small hernias that do not need surgery, a repair may be recommended if you experience:

• Severe acid reflux: This is when stomach acid or food backs up into your throat, causing a burning feeling (heartburn).
• Chest or belly pain: Large hernias can cause pressure or discomfort in the upper abdomen or chest area.
• Trouble swallowing: A hernia can sometimes make it feel like food is getting stuck on the way down.

The goal of the repair is to restore the natural anatomy of your digestive system and improve your quality of life by reducing these symptoms.

How common it is & where it's done

Hiatal hernia repair is a common and well-established procedure. It is often performed using "minimally invasive" techniques, which means the surgeon uses small incisions and a tiny camera to see inside. This approach typically leads to a faster recovery and less discomfort than traditional surgery.

The procedure is usually done in a hospital or a dedicated surgical center. Depending on your health and the type of repair, your clinician may allow you to go home the same day, or you might stay in the hospital for a day or two to ensure you are healing well. Your care team will help determine the best setting for your specific needs.

Recovery: What to Expect

Most patients stay in the hospital for one or two days after the procedure. Your clinician may ask you to follow a special diet, starting with liquids and slowly moving to soft foods. This gives your esophagus (the tube that carries food to your stomach) time to heal. You will likely be encouraged to walk shortly after surgery to help your body recover.

• Activity: You should avoid heavy lifting for several weeks to protect the repair.
• Pain: Mild soreness is normal and can usually be managed with medicine.

Risks & Possible Complications

While hiatal hernia repair is generally safe, all surgeries have some risks. These may include bleeding, infection, or a reaction to anesthesia. Some patients may experience temporary difficulty swallowing or feel extra gas and bloating as their body adjusts.

It is important to watch for signs that you need to contact your care team. Your clinician may suggest calling if you experience:

• A fever or chills.
• Increased redness or swelling near the small incisions.
• Pain that does not get better with medicine.

Outcomes & Long-Term Results

The goal of this surgery is to provide long-term relief from symptoms like heartburn and chest pain. Most people find that their quality of life improves significantly after they have healed. The repair helps keep the stomach in its proper place below the diaphragm (the muscle that separates the chest from the belly).

To help the results last, your clinician may recommend lifestyle changes. These can include eating smaller meals and maintaining a healthy weight to reduce pressure on the repair site.

Emotional Support & Reassurance

Feeling nervous before a surgical procedure is very common. It may help to remember that hiatal hernia repair is a routine procedure designed to help you feel more comfortable and healthy. Many people find that they can return to their favorite activities without the discomfort of acid reflux.

Your healthcare team is there to answer your questions and guide you through the process. Sharing your feelings with family or friends can also provide comfort as you prepare for your recovery.

Why doctors recommend it

A hiatal hernia occurs when the top part of your stomach pushes through an opening in the diaphragm (the large muscle that separates your chest from your abdomen). Your clinician may recommend surgery if you have a large hernia or if your symptoms are not well-controlled by lifestyle changes and medications.

Common reasons for recommending this procedure include:

• Chronic acid reflux or heartburn that does not get better with daily medicine.
• Inflammation or sores in the esophagus (the tube that carries food to your stomach).
• A narrowing of the esophagus that makes it difficult to swallow.
• Chronic bleeding that leads to low red blood cell counts (anemia).

Urgent vs planned treatment

Most hiatal hernia repairs are planned, elective procedures. This means you and your care team have time to discuss the benefits and prepare for the recovery. Planned surgery is typically suggested when symptoms are persistent but not immediately life-threatening.

In some cases, urgent surgery is necessary. This happens if the hernia becomes "strangled," which means the stomach gets trapped and its blood supply is cut off. Your clinician may treat this as an emergency to prevent damage to the stomach tissue. Symptoms like sudden, severe chest pain or the inability to swallow usually signal the need for immediate care.

Goals of treatment

The primary goal of the surgery is to restore your natural anatomy by moving the stomach back into the abdomen where it belongs. The surgeon also works to strengthen the area to prevent the hernia from returning.

Success in treatment often means:

• Relief from symptoms: Reducing or stopping the burning sensation of acid reflux and chest discomfort.
• Improved swallowing: Ensuring food can pass easily into the stomach without getting stuck.
• Prevention: Protecting the esophagus from long-term damage caused by stomach acid.
• Better quality of life: Allowing you to eat, sleep, and exercise with less discomfort.

Who may benefit

A hiatal hernia happens when the top part of your stomach pushes up through the diaphragm. The diaphragm is the large muscle that separates your chest from your belly. While many people have small hernias that do not cause trouble, surgery may be helpful for those with more severe symptoms.

Your clinician may suggest repair if you have chronic acid reflux (GERD) that does not get better with medicine or lifestyle changes. It may also be a good option if you have a large hernia that causes chest pain, trouble swallowing, or shortness of breath. In some cases, surgery is used to prevent serious problems, such as the stomach becoming trapped or twisted.

When it may not be the right option

Surgery is usually not the first step for a hiatal hernia. If your symptoms are mild and can be managed with over-the-counter medicines or changes to your diet, your care team may recommend continuing those treatments instead. Many people live comfortably with a hiatal hernia without ever needing an operation.

Your clinician might also advise against surgery if you have other serious health conditions that could make the procedure or recovery more difficult. They will look at your overall health to decide if the benefits of the repair outweigh the risks for your specific situation.

Questions to ask your care team

Deciding on surgery is a big step. It is helpful to bring a list of questions to your appointment to help you feel more confident in your choice. You might consider asking:

• How will this surgery improve my specific symptoms?
• What are the risks and benefits of this procedure for me?
• Will I still need to take acid reflux medicine after the repair?
• What does the recovery process look like, and how long will I be away from work?
• Are there other treatments we should try before considering surgery?

In the procedure room

When you enter the procedure room, you will meet your surgical team, which includes the surgeon, nurses, and an anesthesiologist. The room is equipped with specialized monitors and lights to help the team care for you safely. You will be helped onto a comfortable table, and the team will perform several safety checks to confirm your information before the procedure begins.

High-level steps

Most hiatal hernia repairs are done using a laparoscopic approach, which is often called "keyhole surgery." This method uses small incisions (cuts) rather than one large opening. Here is what typically happens:

• Creating access: The surgeon makes 3 to 5 small incisions in the upper abdomen.
• Inflating the area: A harmless gas (carbon dioxide) is used to gently inflate the belly. This gives the surgeon a clear view and room to move the tools safely.
• Repositioning the stomach: The surgeon uses a tiny camera and specialized tools to gently pull the stomach back down into the abdomen where it belongs.
• Repairing the diaphragm: The opening in the diaphragm (the muscle that separates the chest from the belly) is tightened with stitches. In some cases, a small piece of mesh may be used to make the repair stronger.
• Preventing reflux: The surgeon may wrap the top part of the stomach around the bottom of the esophagus (the food pipe). This helps prevent stomach acid from backing up.

Anesthesia and pain control

This procedure is performed under general anesthesia. This means you will be in a deep sleep and will not feel any pain or be aware of the surgery while it is happening. A specialist called an anesthesiologist will stay with you the entire time to manage your comfort and safety.

After the surgery, you may feel some soreness at the incision sites. Your clinician may use local numbing medicine around the small cuts to help you feel more comfortable when you first wake up.

Monitoring and safety steps

Your safety is the top priority during the repair. The surgical team uses electronic monitors to keep a constant watch on your heart rate, blood pressure, and oxygen levels. The use of the laparoscopic camera allows the surgeon to see the internal organs in high definition, which helps them avoid nearby nerves and blood vessels.

Immediately after the procedure

Once the repair is finished, you will be moved to a recovery room. As the anesthesia wears off, you will gradually wake up. You might feel a bit groggy or have a dry, sore throat from the breathing tube used during surgery.

It is common to feel some pressure or bloating in your abdomen or even a dull ache in your shoulder. This is usually caused by the gas used to inflate the belly during the procedure and typically goes away within a day or two. Your nurses will help manage any discomfort and may encourage you to sit up or take a short walk to help your body start healing.

Typical procedure length

A hiatal hernia repair usually takes about 2 to 3 hours to complete. The exact time can vary depending on the size of the hernia and your specific anatomy. Your surgical team will keep your loved ones updated on your progress during this time.

Common approaches (open vs minimally invasive)

To repair a hiatal hernia, surgeons generally use one of two methods to reach the stomach and diaphragm. The goal for both is to pull the stomach back into the abdomen and tighten the opening in the diaphragm.

• Minimally invasive surgery: This is a common approach where the surgeon makes several small cuts (incisions) in the belly. They insert a tiny camera and special tools to fix the hernia. This method, which includes laparoscopic and robotic surgery, typically leads to less pain and a faster recovery.
• Open surgery: This involves a single, larger cut. Your clinician may recommend this if you have a very large hernia, significant scar tissue from past surgeries, or if a minimally invasive approach is not safe for your specific anatomy.

Partial vs total

During the repair, the surgeon often performs a step called fundoplication. This involves wrapping the upper part of the stomach around the lower esophagus to strengthen the valve that keeps acid down. Your surgical team will decide how tight this wrap should be based on tests done before surgery.

• Total fundoplication (Nissen): The stomach is wrapped a full 360 degrees around the esophagus. This is a standard approach to create a strong barrier against reflux.
• Partial fundoplication (Toupet): The stomach is wrapped only part of the way (usually 270 degrees). This option is often chosen if the muscles in your esophagus are weak, as a tighter wrap might make swallowing difficult.

Revision or repeat procedures

While hiatal hernia repairs are intended to be long-lasting, symptoms can sometimes return. This might happen if the wrap slips or the hernia comes back. In these cases, a second surgery, known as a revision, may be discussed.

Revision surgery is generally more complex than the first operation. Because there may be scar tissue from the original procedure, surgeons might need to use an open approach rather than a laparoscopic one to safely repair the area again.

Tests and imaging that may be done

Before scheduling your surgery, your care team needs to understand the exact size of the hernia and how well your esophagus is working. This helps them plan the safest approach for your repair. You may undergo a few common tests:

• Barium swallow (esophagram): You drink a chalky liquid that shows up on X-rays. This highlights the shape of your esophagus and stomach.
• Upper endoscopy (EGD): A doctor guides a thin, flexible tube with a camera down your throat to look directly at the hernia and check for inflammation.
• Esophageal manometry: This test measures the strength and coordination of the muscles in your esophagus when you swallow.
• pH study: This measures how much stomach acid is coming up into your esophagus over a 24-hour period.

Medication adjustments

Your surgeon and anesthesia team will review all the medicines, vitamins, and supplements you currently take. It is important to provide them with a complete list. They will tell you exactly which ones to continue and which ones to pause.

Common adjustments may include:

• Blood thinners and NSAIDs: You may be asked to stop taking blood thinners or anti-inflammatory drugs (such as aspirin or ibuprofen) about one week before surgery to lower the risk of bleeding.
• Regular prescriptions: Your doctor may allow you to take certain essential medications on the morning of surgery with a small sip of water.

Only stop or change your medications if your clinician specifically instructs you to do so.

Day-before and day-of instructions

Preparing your body for surgery helps ensure the procedure goes smoothly and lowers the risk of complications. Your clinic will likely give you a checklist to follow.

The day before surgery:

• You may be placed on a clear liquid diet for the entire day. This usually includes broth, gelatin, and juices without pulp.
• Do not eat or drink anything (including water) after midnight unless your care team tells you otherwise. Having an empty stomach is vital for anesthesia safety.

The day of surgery:

• Hygiene: You may be asked to shower with a special antibacterial soap to reduce the risk of infection.
• Clothing: Wear loose, comfortable clothes and flat shoes. Leave jewelry and valuables at home.
• Arrival: Arrive at the hospital or surgery center at your scheduled time to complete paperwork and meet with the nursing and anesthesia teams before the procedure begins.

General surgical risks

Like any operation, hiatal hernia repair carries some standard risks. Your surgical team takes many precautions to keep these low. General risks associated with anesthesia (the medicine used to keep you asleep) include breathing problems or reactions to medications.

Other general risks include bleeding or infection at the incision site. While blood clots in the legs can occur after surgery, your care team will likely encourage you to move around as soon as possible to help prevent them.

Procedure-specific complications

Because this surgery involves the stomach and esophagus, there are specific side effects that can happen. Many of these are temporary as your body heals.

• Difficulty swallowing: You may feel like food sticks in your throat. This is often caused by swelling near the repair site and usually improves with time.
• Gas bloat syndrome: The surgery tightens the opening between the stomach and esophagus to stop acid reflux. This can sometimes make it hard to burp or vomit, leading to a feeling of trapped gas or bloating.
• Injury to nearby organs: In rare cases, nearby parts of the body, such as the stomach, esophagus, or spleen, may be affected during the procedure.
• Recurrence: It is possible for the hernia to come back (recur) over time, which might require further monitoring.

How complications are treated

Most complications are manageable and treatable. If you experience an infection, your clinician may prescribe antibiotics. For difficulty swallowing, your doctor will likely recommend a specific diet—starting with liquids and soft foods—to allow swelling to go down comfortably.

Gas bloat is often managed by changing your eating habits, such as eating smaller meals and avoiding carbonated drinks. If a hernia returns or if the repair is too tight, your surgeon may discuss additional options, but often these issues can be managed without a second surgery.

Pain control medicines

Managing discomfort is a key part of your recovery. Your clinician may use a combination of different medicines to keep you comfortable. This often includes over-the-counter options like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). These help reduce swelling and soreness at the incision sites, which are the small cuts made during surgery.

For stronger pain, your care team might prescribe opioid medications for a short time. Because these can cause side effects like sleepiness or constipation, they are usually used only when needed. Your clinician will tailor your pain plan to your specific health history and any allergies you may have.

Antibiotics

Antibiotics are medicines used to prevent or treat infections caused by bacteria. Before your hiatal hernia repair begins, your surgical team will likely give you a dose of antibiotics through an IV (a small tube in your vein). This is a standard safety step to help keep the surgical area clean and reduce the risk of infection after the procedure.

In most cases, you will not need to continue taking antibiotics once you go home unless your clinician sees a specific reason to do so. It is important to tell your healthcare team if you have ever had an allergic reaction to any antibiotics, such as penicillin, so they can choose the safest option for you.

Blood thinners and clot prevention

During and after surgery, your activity level is lower than usual, which can increase the risk of blood clots. To help prevent this, your clinician may use blood thinners, also called anticoagulants. These medicines help keep the blood flowing smoothly through your veins.

Commonly used options include low doses of heparin or enoxaparin, often given as a small injection. Your care team will also encourage you to walk soon after surgery to help your circulation. They will carefully monitor you to balance the need for clot prevention with the risk of bleeding, ensuring the plan is safe for your specific needs.

Emergency warning signs

While serious complications are rare, it is important to act quickly if you have signs of a medical emergency. Call 911 or go to the nearest emergency room if you experience:

• Trouble breathing: Sudden shortness of breath or difficulty catching your breath.
• Chest pain: Severe pain or pressure in your chest.
• Signs of internal bleeding: Vomiting blood or material that looks like coffee grounds, or passing black, tarry stools.
• Severe abdominal pain: Sudden or intense belly pain that does not go away.

Call your surgeon or clinic if…

Recovering at home takes time, and your care team is there to help if things do not feel right. Contact your surgeon or clinic if you notice:

• Signs of infection: A fever over 101°F (38.3°C), chills, or redness, warmth, and drainage (pus) at your incision sites.
• Stomach issues: Nausea or vomiting that stops you from drinking fluids or taking your medicine.
• Pain management problems: Pain that gets worse or is not helped by your prescribed medication.
• Bathroom trouble: Difficulty urinating or inability to pass gas or move your bowels.

Expected vs concerning symptoms

Knowing what is normal during healing can help you stay calm. Most people experience some discomfort as their body adjusts to the repair.

• Gas and bloating: It is very common to feel bloated or have gas pains after surgery. You may even feel pain in your shoulder; this is often caused by the gas used during the procedure and usually goes away with walking.
• Swallowing difficulties: You may feel like food is sticking in your chest or find it hard to swallow solid foods. This is often due to swelling where the hernia was repaired. It typically improves as the swelling goes down.

However, certain changes need medical attention. Call your doctor if:

• Swallowing gets worse: You cannot swallow liquids or the difficulty swallowing does not improve after a few weeks.
• Leg pain: You have new pain, swelling, or redness in one of your legs, which could be a sign of a blood clot.

Non-surgical treatments

For many people, a hiatal hernia (when the top of the stomach bulges through the diaphragm muscle) can be managed without surgery. The primary goal of non-surgical treatment is to control acid reflux and prevent irritation of the esophagus, which is the tube connecting your throat to your stomach.

Your clinician may suggest lifestyle changes and medications, such as:

• Weight management: Losing weight can help reduce the pressure on your abdomen and the diaphragm.
• Dietary changes: Eating smaller, more frequent meals and avoiding "trigger" foods like caffeine, chocolate, or spicy dishes may help.
• Positioning: Staying upright for at least two to three hours after eating and raising the head of your bed can prevent acid from backing up.
• Medications: Over-the-counter or prescription drugs, such as proton pump inhibitors (PPIs) or H2 blockers, are often used to reduce the amount of acid your stomach produces.

Watchful waiting

If your hiatal hernia is small or does not cause any bothersome symptoms, your clinician may recommend a "watchful waiting" approach. This means you will not have surgery or intensive treatment right away. Instead, you and your medical team will monitor the condition during regular check-ups to see if it changes over time.

Watchful waiting is very common for "sliding" hiatal hernias, where the stomach moves up and down through the diaphragm. As long as you feel well and medications are managing any mild reflux, surgery is often not necessary. Your clinician will help you decide if this conservative approach is safe for your specific type of hernia.

When surgery becomes the best option

While many hernias are managed with medicine, surgery may become the best choice if your symptoms stop responding to non-surgical treatments. If you continue to have severe heartburn, chest pain, or regurgitation despite taking daily medication, your clinician may discuss surgical repair to improve your quality of life.

There are also specific signs that may trigger a need for surgery to prevent serious complications. These include:

• Difficulty swallowing: If the hernia causes the esophagus to narrow or if the stomach is poorly positioned, it may become hard to swallow food.
• Chronic bleeding: Some hernias can cause slow blood loss or ulcers in the stomach lining.
• Risk of twisting: In some types of hernias, the stomach can twist (called a volvulus) or become trapped, which can cut off blood flow.
• Respiratory issues: A very large hernia may press against the lungs, making it difficult to breathe deeply.

Your clinician will weigh these risks against the benefits of surgery to help you make the right decision for your health.

Hospital services that commonly perform this surgery

Hiatal hernia repairs are usually performed in hospitals with specialized surgical departments. You will often find these services within a General Surgery department or a specialized Digestive Health center. These centers bring together different experts to coordinate your care before and after the procedure.

Common departments involved in your care may include:

• Gastroenterology: Doctors who specialize in the digestive system and help diagnose the hernia.
• Thoracic or Foregut Surgery: Surgeons who focus on the chest and the upper part of the digestive tract.
• Minimally Invasive Surgery: Units that use small incisions and cameras (laparoscopy) to perform the repair, which often leads to a faster recovery.

Patient resources and support services

Many hospitals offer resources to help you prepare for and recover from surgery. Because your diet will change temporarily after the procedure, access to a registered dietitian is a common and helpful resource. They can help you plan soft-food meals while your esophagus (the tube connecting the throat to the stomach) heals.

Support services may also include:

• Pre-operative education classes or videos to explain what to expect on the day of surgery.
• Pain management teams to help keep you comfortable during your hospital stay.
• Online patient portals where you can message your care team and view your recovery instructions.

Questions for choosing where to have surgery

Choosing the right facility is an important step in your health journey. Your clinician may suggest a hospital based on their experience with hiatal hernia repairs. You might consider using this checklist when looking at different locations:

• How many hiatal hernia repairs does this hospital perform each year?
• Does the facility offer minimally invasive or laparoscopic surgery options?
• Is there a dedicated team of specialists, such as dietitians and GI experts, available to help with my recovery?
• What kind of follow-up care and support is provided after I go home?
• Does the hospital have experience with the specific type of repair my clinician recommended?

Conditions commonly treated by this procedure

Hiatal hernia repair is primarily used to address a hiatal hernia. This condition occurs when the upper part of the stomach pushes through an opening in the diaphragm, which is the large muscle that separates the chest from the abdomen. Your clinician may suggest this surgery if the hernia is causing significant discomfort or if there is a risk of the stomach becoming trapped.

This procedure is also frequently used to treat Gastroesophageal Reflux Disease (GERD). While many people manage GERD with lifestyle changes or medication, surgery may be an option if those treatments are not effective. The goal is to move the stomach back to its proper place and reinforce the area to prevent acid from backing up into the esophagus.

Related symptoms people search for

People considering this procedure often experience a variety of symptoms that can affect their daily life. These may include:

• Heartburn: A burning sensation in the chest or throat, often after eating.
• Regurgitation: A sour or bitter-tasting fluid backing up into the throat or mouth.
• Difficulty swallowing: A feeling that food is moving slowly or getting stuck on the way down.
• Chest pain: Discomfort in the chest area, which should always be evaluated by a clinician to rule out other causes.

In some cases, a hiatal hernia can lead to shortness of breath or feeling full very quickly after starting a meal. If you notice these signs, your clinician can help determine if a hiatal hernia is the cause and discuss the best steps for your care.

Evidence overview

Medical experts generally consider hiatal hernia repair to be an effective long-term solution for patients with severe symptoms, such as acid reflux (GERD), that do not respond well to medication. The surgery aims to return the stomach to its proper place and tighten the opening in the diaphragm.

Most repairs are performed using laparoscopic surgery. This is a minimally invasive technique that uses small cuts and a camera. Evidence suggests that this approach leads to high satisfaction rates, with most patients reporting significant relief from heartburn and other symptoms after recovery.

Safety notes and individualized care

While hiatal hernia repair is a common procedure, your clinician will review your medical history to ensure it is safe for you. Factors like your age, the size of the hernia, and other health conditions help determine the best surgical approach.

Like any major operation, there are potential risks. These may include:

• General surgical risks: These can include infection, bleeding, or reactions to anesthesia.
• Swallowing difficulties: Some patients may have trouble swallowing temporarily as the esophagus heals.
• Gas bloat: You might feel bloated or unable to burp easily because the stomach wrap prevents gas from escaping upward.
• Organ injury: In rare cases, nearby organs like the spleen or stomach could be affected.

Recovery times differ for everyone. Most people spend a short time in the hospital and take a few weeks to fully recover at home. Your doctor will give you specific instructions on diet and activity to help you heal safely.

Sources used

The information in this section is based on guidance from the following sources:

• UCLA Health
• MedlinePlus (U.S. National Library of Medicine)